Migraines and the Environment

by Kelly James-Enger

IF YOU SUFFER from migraines, you may already be aware of some of the internal triggers of your headaches. The foods you eat, the way you sit, and even a problem with your bite can all cause migraines in people who are susceptible to them. However, your external environment — which can be more difficult to modify — can also play a role

These external migraine triggers are quite common — an online survey conducted by the National Headache Foundation earlier this year polled 305 migraine sufferers and found that 85% of them have had migraines triggered by environmental causes.

Some of the most common triggers included:

• Smoke-filled or poorly ventilated rooms (64% said this could trigger a migraine);

• Changes in altitude or barometric pressure, such as when flying or due to a change in the weather (57% of people reported this triggered migraines)

• Bright or flickering lights (52% said this triggered migraines).

Survey respondents also listed loud or repetitive sounds and intense smells or vapors as migraine-triggers. An earlier survey of 100 migraine sufferers published in 2002 found that three quarters listed ‘ensorial stimuli’ as triggers, and nearly half said environmental factors played a role in causing their headaches.

According to George Nissan, D.O. a staff physician at the Diamond Headache Clinic in Chicago, about half his patients complain that their environment causes migraines, particularly when weather shifts change the barometric pressure. “Sometimes they say they notice those kinds of factors even before they know what the weather is going to be like that day,” says Nissan.

“Typically the external triggers that are most commonly reported are weather-related, but patients also commonly report bright lights, loud noises, odors, perfumes and so forth as being common triggers as well,” says Vincent Martin, M.D., professor of medicine at University of Cincinnati’s College of Medicine and co-director of the Cincinnati Headache Center.

The time between exposure to a potential trigger and the onset of the migraine depends on the person. “Some people notice an immediate trigger — sometimes within minutes to an hour — and some have a more delayed reaction,” says Nissan.

Identifying the Trigger

That time lag can make it more difficult to pinpoint potential migraine triggers. “Every patient has a different type of trigger,” says Dr. Nissan. “It’s important to keep a headache diary to see if there are triggers that the patient can map out on his or her own.” He adds that while you may have several environmental trigger, one may stand out as the most severe.

Keeping a headache diary of your day-to-day life can help you identify potential triggers you may not have considered. For example, if you find you get a migraine after watching the game in a smoky bar, it may not be what you ate or drank triggered your headache, but rather the smoky atmosphere.

Changing Your Environment

Short of relocating, you can’t escape the weather if you find that an increase or decrease in barometric pressure tends to trigger a migraine. But in other cases, you may be able to avoid other potential migraine causes. For example, let people around you know that you’re sensitive to smells, especially if you work with anyone who tends to wear heavy perfume. Make sure your work and home environments are well-ventilated, and avoid bright lights and loud, jarring noises if you know they tend to cause problems.

In addition to avoiding possible problems, there are medications to both help prevent and treat environmentally-triggered migraines. “Obviously you want to avoid environmental triggers like perfumes and allergens, and things that you can change in your lifestyle,” says Dr. Nissan. If, however, weather or other factors outside your control are the primary culprit, you may want to consider seeing asking your physician about preventative therapy.

“If you can reduce the sensitivity of the central nervous system for migraine through preventative medications or through behavioral changes, then you can oftentimes you can reduce sensitivity to triggers,” says Dr. Martin. In addition to avoiding environmental triggers, he suggests living “a healthy neurological lifestyle” — for example, waking at the same time each day, trying to minimize stress in your life, and eating regularly — to help reduce your risk of getting migraines.

“Following that healthy neurological lifestyle and then going on preventative medication to try to tame down that overactive central nervous system can be a huge help in terms of reducing your sensitivity to environmental triggers,” says Dr. Martin. •

from the March-April 2009 issue

A survey conducted by the National Headache Foundation found that 85% of migraine sufferers have had migraines triggered by environmental causes.